What Is Undifferentiated Schizophrenia?

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Undifferentiated schizophrenia is a subtype of schizophrenia in which an individual meets the criteria for a diagnosis of schizophrenia, and who exhibits symptoms that fit more than one subtype of schizophrenia, but not enough of any one subtype to be classified as that subtype.

man with schizophrenia

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Definition of Undifferentiated Schizophrenia?

Schizophrenia is a mental health condition that interferes with a person's perception of reality. Previously, schizophrenia was divided into five subtypes in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association.

The five subtypes of schizophrenia are:

  • Paranoid: Positive symptoms like delusions and hallucinations are most dominant.
  • Hebephrenic/disorganized: Disorganized symptoms, such as disorganized thought, disorganized speech, and flat affect, are most dominant.
  • Residual: A person meets the criteria for a diagnosis of schizophrenia, but the symptoms are in a milder form.
  • Catatonic: A person meets the criteria for schizophrenia and has additional symptoms of catatonia (excessive movement or decreased movement).
  • Undifferentiated: A person exhibits the symptoms of more than one subtype of schizophrenia, but does not exhibit enough symptoms of one subtype to be classified as that subtype.

The most recent edition of the DSM (DSM-5) no longer includes these subtypes as distinct conditions because of the overlap of symptoms between the subtypes, which hindered a diagnosis.

The five subtypes are still used as a way to understand how an individual's experience with schizophrenia is manifesting, and as a guide for tailoring treatment to each person.

With undifferentiated schizophrenia, a person meets the criteria set out by the DSM-5 for schizophrenia, but their symptoms do not fit neatly into any one subtype.

Symptoms

For a diagnosis of any type of schizophrenia, a person must exhibit at least two of the following symptom types, with at least one of the symptoms being delusions, hallucinations, or disorganized speech. The symptoms include:

  • Delusions
  • Hallucinations
  • Disorganized speech (e.g., frequent derailment or incoherence)
  • Grossly disorganized or catatonic behavior
  • Negative symptoms (i.e., diminished emotional expression or avolition).

Symptoms must persist for at least six months and must cause significant difficulties in the level of functioning in one or more major life areas, such as work, interpersonal relations, or self-care.

Unlike the other subtypes, undifferentiated schizophrenia does not have hallmark symptoms. The classification of undifferentiated schizophrenia results from the range of symptoms presented rather than the presence of specific symptoms.

Symptoms Are Not Static

Symptoms of schizophrenia do not always occur all at the same time, and can change over time.

People with undifferentiated schizophrenia can experience any of the following symptoms.

Positive Symptoms

This refers to characteristics that have developed that should not be there. This includes:

  • Hallucinations: A sensory experience that is not real, such as hearing voices, or seeing things that are not there.
  • Delusions: Erroneous but firmly held beliefs, despite concrete evidence that disputes the belief or a lack of factual evidence to back up the belief. This might include thinking people on TV are sending the person special messages, or paranoia, such as thinking people are spying on them or "out to get them".
  • Thought disorder: Unusual thinking or disorganized speech.
  • Catatonia or other movement disorders: Excessive movement or decreased movement.

Negative Symptoms

Negative symptoms refer to healthy characteristics or behaviors that have ceased or the lack of characteristics that should be there. This includes:

  • Loss of motivation
  • Social withdrawal
  • Lack of interest or enjoyment in activities
  • "Flat affect", meaning a reduced or lack of facial expression and/or vocal intonation
  • Difficulty expressing emotion
  • Difficulty planning activities
  • Difficulty beginning and sustaining activities
  • Reduced feelings of pleasure
  • Reduced speaking

Cognitive Symptoms

Cognitive symptoms include:

  • Problems with attention
  • Difficulty concentrating or focusing
  • Problems with memory, such as remembering appointments
  • Problems with processing information
  • Problems with decision making
  • Difficulty using information immediately after learning it
  • Confused thinking and speech
  • Rambling, incoherent speech
  • "Word salad" (seemingly random words or ideas strung together, switching quickly between unrelated thoughts)
  • Bizarre behavior
  • Childlike behavior
  • Inappropriate appearance
  • Behavior that is inappropriate for the situation, such as laughing at a funeral
  • Lack of good hygiene habits

Diagnosis

To determine if a person has schizophrenia, a mental health professional will perform several procedures.

Examination

During an examination, a healthcare provider will:

  • Ask about symptoms
  • Review the person's medical history
  • Review the person's family medical history
  • Possibly perform a physical examination
  • Look for signs that the symptoms are a result of a condition other than schizophrenia

Lab Tests

There is no lab test for schizophrenia, but blood, urine, or other lab tests may be ordered to see if other conditions are present that may explain the person's symptoms.

Depending on the situation, a healthcare provider may order a substance test, particularly with adolescents.

Imaging Tests

A magnetic resonance imaging (MRI) or a computerized tomography (CT) may be run to look for a physical cause for the person's symptoms, such as a brain tumor.

To determine that a person has undifferentiated schizophrenia, a mental health expert will examine the person's symptoms to see if they meet the criteria for the other schizophrenia subtypes.

If the person's symptoms match more than one subtype but do not meet the criteria for any single subtype, the person may be given a classification of undifferentiated schizophrenia. In this sense, the classification of undifferentiated schizophrenia is made through a process of elimination.

Causes

The specific cause of schizophrenia, and by extension undifferentiated schizophrenia, is not known, but there are several theories.

Theorized causes and risk factors for undifferentiated schizophrenia include:

Age

While undifferentiated schizophrenia can occur at any age, it tends to be developed during the age range of the late teens to the early thirties.

Genetics

Undifferentiated schizophrenia appears to run in families. While having schizophrenia in the family does not mean a person will develop schizophrenia, it does appear to increase the risk.

Compared to the 1% prevalence of schizophrenia in the general population, there is a 10% prevalence among people who have a biological parent or sibling with schizophrenia. The highest risk is associated with identical twins.

Having a second-degree relative such as aunts, uncles, grandparents, or cousins, who has schizophrenia also increases a person's chances of developing the condition.

It is likely that multiple genes are involved in the development of schizophrenia.

Environment

It is believed that an interaction between genetics and environmental factors influence the development of undifferentiated schizophrenia. Some environmental risk factors include:

  • Living in poverty
  • Living with stress
  • Prenatal exposure to viruses or pathogens
  • Prenatal malnutrition
  • History of abuse or neglect

Substance Use

While drugs do not cause undifferentiated schizophrenia, they have been linked to an increased risk of developing schizophrenia in those who are susceptible.

  • Schizophrenia is linked most closely to:
  • Cannabis
  • Cocaine
  • LSD
  • Amphetamines

Research has shown a link between excessive use of cannabis by adolescents and the development of schizophrenia.

Brain Chemistry

Dysfunctions of the neurotransmitters dopamine, serotonin, norepinephrine, and epinephrine have been linked to undifferentiated schizophrenia.

More specifically, excessive dopamine activity is linked to hallucinations, agitation, and delusions, while high norepinephrine is linked to positive symptoms of schizophrenia.

Brain Physiology

Differences in brain structure and function are believed to play a part in undifferentiated schizophrenia.

For example:

  • Differences in the volumes of specific components of the brain
  • Differences in the way regions of the brain are connected and interact

These brain differences may begin before birth. Schizophrenia or other forms of psychosis may be triggered by changes to the brain during puberty in those who are susceptible due to genetics, environmental factors, or brain differences.

Treatment

Treatment options for schizophrenia can vary from person to person. Available treatment options are outlined below.

Medication

Medication is the most common treatment for undifferentiated schizophrenia, particularly antipsychotics.

Antipsychotic medications can be taken in pill or liquid form, or by injection.

Some antipsychotics include:

  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)
  • Aripiprazole (Abilify)
  • Paliperidone (Invega)

Side effects of antipsychotics may include:

  • Weight gain
  • Dry mouth
  • Restlessness
  • Drowsiness 

Some people may be prescribed mood stabilizers such as:

  • Lithium (Lithobid)
  • Divalproex (Depakote)
  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)

In some cases, people with undifferentiated schizophrenia may take antidepressants such as:

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq)
  • Duloxetine (Cymbalta)
  • Bupropion (Wellbutrin)

Never Go "Cold Turkey"

Stopping medication abruptly can be dangerous. Always consult your healthcare provider before stopping a medication or changing your medication plan.

Cognitive Behavioral Therapy (CBT)

CBT may help change destructive thought patterns in people with undifferentiated schizophrenia.

With CBT, people identify thought patterns, and change disruptive ones using tools such as journaling, relaxation, and role-playing.

Family Education and Support

These programs are geared towards the family members and close relationships of people who have schizophrenia. They aim to help loved ones understand the condition, learn ways to support the person with undifferentiated schizophrenia, and find support for themselves.

These programs can be done individually, as a family, or as a group with other families.

Coordinated Specialty Care

This type of treatment involves a team of specialists working together to provide help such as:

  • Psychotherapy
  • Medication management
  • Case management
  • Employment and education support
  • Family education and support

It is used in people in an early stage of schizophrenia called first-episode psychosis.

Assertive Community Treatment (ACT)

ACT aims to reduce the number of hospitalizations for people with undifferentiated schizophrenia, and the incidences of people without housing.

It involves:

  • A multidisciplinary team, including a medication prescriber
  • A shared caseload among team members
  • Direct service provided by team members
  • A high frequency of contact with the person who has schizophrenia
  • A low ratio between staff and the people with schizophrenia
  • Outreach to people with schizophrenia in the community

Social Skills Training

This treatment uses rehearsing or role-playing real-life situations to help a person with undifferentiated schizophrenia re-learn how to act and interact appropriately in social settings.

Supported Employment

This program helps people with undifferentiated schizophrenia enter the workforce with support such as assistance with constructing resumes, preparing for job interviews, and connecting them with employers who hire and support people with mental illness.

Substance Use Treatment

Because excessive substance use can make undifferentiated schizophrenia symptoms worse, and up to 50% of people with schizophrenia have substance use disorders, substance use treatment is often a part of treatment for undifferentiated schizophrenia.

Help Is Available

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Coping

Schizophrenia is a life-long condition, so finding coping strategies is important.

Some ways to help manage living with undifferentiated schizophrenia include:

  • With the help of professionals, create and maintain a treatment plan.
  • If prescribed medication, take it regularly as directed and do not stop without consulting a healthcare provider.
  • Eat a healthy diet. Consulting with a dietitian may be helpful.
  • Get plenty of exercise. Exercise is good for both physical and mental health.
  • Manage and minimize stress using techniques such as relaxation, knowing and respecting your limits, and managing your emotions.
  • Get plenty of sleep.
  • Avoid substances like alcohol, drugs, and smoking.
  • Speak with a healthcare provider about changing or adjusting medications if they are not effective enough or are causing bothersome side-effects.
  • Set goals and work towards them.

Finding Support

Living with undifferentiated schizophrenia is difficult to do alone. Having the support of others can make treatment and management of undifferentiated schizophrenia more effective, and make life with schizophrenia more enjoyable.

Some ways to find support include:

  • Reaching out to trusted friends, family, and loved ones
  • Joining activities or groups involving things you enjoy such as sports, volunteering, or hobbies
  • Joining local clubs or organizations
  • Finding a living environment that makes you feel safe and supports your needs, whether that means living alone, community or supportive living, living with friends or family, or something else
  • Contacting support services in your area

Online Support Groups Can Be A Great Resource

A Word From Verywell

Undifferentiated schizophrenia can be hard to diagnose and difficult to live with, but with proper support and treatment is can be manageable.

If you are experiencing symptoms of undifferentiated schizophrenia, book an appointment to see your healthcare provider or a mental health professional to get a proper diagnosis, and find a treatment plan that works for you.

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Article Sources
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